US11890134B2 - Methods and systems for controlled deployment of needle structures in tissue - Google Patents

Abstract

A system for deploying needles in tissue includes a controller and a visual display. A treatment probe has both a needle and tines deployable from the needle which may be advanced into the tissue. The treatment probe also has adjustable stops which control the deployed positions of both the needle and the tines. The adjustable stops are coupled to the controller so that the virtual treatment and safety boundaries resulting from the treatment can be presented on the visual display prior to actual deployment of the system.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No. 15/793,874, filed Oct. 25, 2017, now U.S. Pat. No. 10,856,838; which is a continuation of patent application Ser. No. 13/801,782, filed Mar. 13, 2013, now U.S. Pat. No. 9,861,336; which claims the benefit of Provisional Application No. 61/698,196, filed Sep. 7, 2012; the full disclosures of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

Field of the invention. The present invention relates generally to medical methods and apparatus. More particularly, the present invention relates to methods and systems for controlling the deployment of needles using treatment and safety boundaries projected onto an image of tissue to be treated.

Current medical treatments of organs and tissues within a patient's body often use a needle or other elongate body for delivery of energy, therapeutic agents or the like. Optionally the methods use ultrasound imaging to observe and identify a treatment target and track the position of the needle relative to the treatment target.

Of particular interest to the present invention, a treatment for uterine fibroids has recently been proposed which relies on the transvaginal or laparoscopic positioning of a treatment device in the patient's uterus. A radiofrequency or other energy or therapeutic delivery needle is deployed from the device into the fibroid, and energy and/or therapeutic substances are delivered in order to ablate or treat the fibroid. To facilitate locating the fibroids and positioning the needles within the fibroids, the device includes an ultrasonic imaging array with an adjustable field of view in a generally forward or lateral direction relative to an axial shaft which carries the needle. The needle is advanced from the shaft and across the field of view so that the needle can be visualized and directed into the tissue and the targeted fibroid.

While effective and very beneficial for patients, such needle ablation and treatment protocols face several challenges. First, initial deployment of the needle can be difficult, particularly for physicians who have less experience. While the physician can view the tissue and target anatomy in real time on an imaging screen, it can be difficult to precisely predict the path the needle will take and assess its final treatment position. While the needle can certainly be partially or fully retracted and redeployed, it would be advantageous to minimize the number of deployments required before treatment is effected.

A second challenge comes after the needle has been deployed. While the position of the needle can be observed on the ultrasonic or other visual image, the treatment volume resulting from energy or other therapeutic delivery can be difficult to predict. As with initial positioning, experience will help but it would be desirable to reduce the need to exercise judgment and conjecture.

A third challenge lies in assuring that nearby sensitive tissue structures, such as the serosa surrounding the myometrium, are not unintentionally damaged. As with judging the treatment volume, predicting the safety margin of the treatment can be difficult.

U.S. Pat. No. 8,088,072, commonly assigned with the present application, describes a system for projecting safety and treatment boundaries on a real time image of the fibroid or other tissue structure to be treated. While very effective when used with single needles, the system of the '072 patent is not optimized for use with multiple needle/tine assemblies, such as those taught in commonly owned U.S. Pat. Nos. 8,206,300 and 8,262,574.

For these reasons, it would be desirable to provide improved systems and methods for the deployment of energy delivery and other needles within ultrasonic or other imaging fields of view in energy delivery or other therapeutic protocols. It would be particularly useful to provide the treating physician with information which would assist in initial deployment of a plurality of needles or tines in order to improve the likelihood that the needle assembly will be properly positioned relative to a targeted anatomy to be treated. It would also be desirable to provide feedback to the physician to assist in accurately predicting a treatment volume. Such information should allow the physician, if necessary, to reposition the probe in order to increase the likelihood of fully treating the anatomy. Furthermore, it would be desirable to provide feedback to the physician allowing the physician to assess a safety margin so that sensitive tissue structures are not damaged. All such feedback or other information are preferably provided visually on the ultrasonic or other imaging screen so that the needle position can be quickly predicted, assessed, and treatment initiated. It would be further desirable if the feedback information were presented on a display screen in response to manipulating the probe while minimizing the need to enter data or commands onto a system controller or display, and still further desirable if such manipulation of the probe could set stops or other limits which controlled the extent of subsequent needle deployment. At least some of these objectives will be met by the inventions described hereinafter.

2. Description of the Background Art. U.S. Pat. Nos. 8,088,072; 8,206,300 and 8,262,574 have been described above and are incorporated herein by reference. U.S. Pat. No. 7,918,795, commonly assigned with the present application, describes probes useful for both imaging and treating uterine fibroids, which probes could be used in the systems and methods of the present application and is incorporated herein by reference. Other commonly assigned patents and published applications describing probes useful for treating uterine fibroids in the systems include U.S. Pat. Nos. 7,874,986 and 7,815,571; and U.S. Patent Publications 2007/0179380 and 2008/0033493. See also U.S. Pat. No. 6,050,992 and U.S. patent Publication 2007/0006215.

BRIEF SUMMARY OF THE INVENTION

The present invention provides methods and systems for deploying needle structures in tissue. The needle structures may in some cases comprise a single needle but in most cases will comprise multiple needles or needle and tine assemblies as described in more detail below. The needle structures are usually intended to deliver a therapy to the tissue, most typically being configured to deliver radiofrequency energy, plasma energy, therapeutic ultrasound energy, microwave energy, heat, cold (cryogenic treatment), or other energy to ablate or otherwise modify a target tissue or targeted anatomy within the tissue. Alternatively, the needle structures could also provide drug or other substance delivery, morcellation, or other tissue treatments which can be effected using a needle structure.

The methods and systems of the present invention are particularly suitable for treating fibroids in a patient's uterus where a probe carrying the needle structure and an imaging transducer, typically an ultrasonic imaging transducer, is introduced transvaginally and transcervically into the uterus, or in other cases laparoscopically into and through an exterior of the uterus or other organ or tissue target. The probe is manipulated within the uterus to deliver ablative energy to the fibroid as described in more detail below. In most embodiments of the present invention, the needle structure is “virtually” deployed on a real-time image of the tissue prior to actual deployment of the needle in the actual tissue. Treatment and/or safety boundaries within the tissue will also be determined and optionally adjusted prior to the actual deployment of the needle structure. In other embodiments, the actual position of the needle structure may be tracked and the corresponding treatment and/or safety boundaries projected on the screen in real time. In all embodiments, the treatment and safety boundaries can be checked before treatment is commenced.

The methods and systems of the present invention further provide that, once the parameters of the virtual deployment have been selected using the virtual images, the needle structure is actually deployed in the real tissue at a location and/or in a pattern which matches the virtual deployment configuration. In a first exemplary embodiment, such deployment is achieved by manipulating “stops” or other mechanical elements on the probe during the virtual deployment on the real-time image. The stop positions correspond to actual needle deployment positions (the stops typically act as limits which allow the needle structure to be deployed to a specific location and in a specific pattern), and the system calculates the treatment and/or safety boundaries based on the stop positions as well as on energy delivery data which is supplied to or generated by a system controller. This system may alternatively or additionally track the position of the treatment probe and/or needle structure in the uterus, thus allowing the treatment and safety boundaries which are projected upon the real-time image of the tissue to be calculated and/or updated as the probe is moved and the needle structure advanced by the treating physician. In the first exemplary embodiment, once the treatment region and/or safety boundary are properly positioned on the real-time image relative to the anatomy to be treated, the physician may hold the probe in place and deploy the needle structure until it reaches its “stop” position(s) which have been preset into the probe during the initial imaging and set-up phase of the treatment. In some cases, the stops can be automatically set as the physician manipulates the treatment and/or safety boundary on the screen using the controls on the treatment probe. In alternative embodiments, the physician may manipulate the probe and advance the needle structure while viewing the safety and/or treatment boundaries in real time without having previewed the virtual projections.

In the exemplary embodiments, at least one main or central needle will be deployed from the treatment probe, and a plurality of tines or secondary needles will be deployed from the main or central needle(s). Most often, there will be a single main needle which is deployed distally from a shaft of the probe along a central axis thereof. A plurality of tines will then be advanced from the single needle in a distally diverging pattern. In other embodiments, a plurality of needles or tines may be advanced from the probe without use of a main or central needle. In such cases, the needles or tines will typically expand or diverge into a three-dimensional array as they are advanced distally.

Exemplary anatomical features that may be imaged and subsequently treated include fibroids, tumors, encapsulated tissue masses, pseudoencapsulated tissue masses, and the like. Of particular interest of the present invention, the probe may be positioned in the uterus and the needle structure deployed to a location proximate to or within a fibroid located in the myometrium tissue of the uterus. In such cases, it will be desirable to also image the serosa which surrounds the myometrium and/or other sensitive anatomical features that could be damaged by the energy-mediated treatments described herein.

As used herein, a treatment region is defined by a treatment boundary which is calculated by the system controller based upon the needle structure deployment configuration (either as set by the “stops” or as calculated in real-time as the needle structure is deployed) and the energy delivery parameters set by or input into the system controller. Energy or other therapy delivered by the needle structure deployed in the selected pattern at the selected location will effectively treat the target tissue to achieve ablation or other therapeutic results. As described below, it will thus be desirable to manipulate the probe as well as the needle structure stop(s) and/or actual needle structure so that the treatment region at least partially surrounds the anatomy to be treated as seen on the real-time image display of the system.

As further used herein, the safety region is defined by a safety boundary which is calculated by the system. As with the treatment region, the safety boundary is calculated based upon the needle structure “stops” and/or actual needle structure positions which have been set or adjusted on the treatment probe by the physician as well as the energy delivery parameters which are input into or set by the system controller. The safety boundary will differ from the treatment boundary in that the safety boundary will be set at a minimum threshold distance beyond the boundary of the tissue treatment region where the risk of damaging tissue is reduced or eliminated entirely.

In a first aspect of the present invention, methods for deploying a needle structure in tissue comprise positioning a treatment probe having a deployable needle structure near a surface of the tissue to be treated, for example, adjacent to a uterine wall over the myometrium of a uterus. A real-time image of the tissue is provided, typically using an imaging transducer such as an ultrasonic array which is carried by the treatment probe, and projected onto a display connected to a controller. The real-time image includes an anatomical feature to be treated, such as a fibroid. At least one of a treatment region and a safety region is projected onto the real-time image prior to deploying the needle structure. A size and/or a position of a boundary of the treatment region and/or the safety region is then adjusted on the real-time image still prior to deploying the needle structure. After the boundary(ies) of the treatment region and/or the safety region are properly positioned on the real-time image relative to the anatomy to be treated, the needle structure may be deployed from the probe into the tissue to provide treatment within the projected treatment/safety boundary after the boundary has been adjusted.

The boundary of the treatment region and/or safety region can be moved or adjusted in several ways. First, manual movement of the probe by the physician will cause the real time image of the tissue and anatomy projected on the screen to move relative to the treatment/safety boundary(ies) projected on the screen. Since the position(s) of the treatment and/or safety boundary projected on the screen depends on the calculated position of the needle structure, it will be appreciated that movement of the probe itself will cause the calculated needle position to move within the real-time image. In addition to such gross movement of the treatment probe in the uterus, the position of the treatment or safety region projected on the real-time image can be adjusted by controls on the probe, e.g. by manually positioning a needle stop element provided on the probe. The needle stop element provides a physical limit on deploying at least one needle of the needle structure so that when the needle is actually deployed in tissue, the needle will be precisely located at the position determined by the needle stop. Prior to deployment, the position of the needle stop itself is tracked by the system controller and used to calculate the position(s) of the treatment and/or safety boundaries.

In specific embodiments, one or more sensor(s) on the probe track(s) movement of the stop(s) in order to reposition and/or resize the projected boundaries. For example, a rotary sensor could be provided on the targeting knob so that when the knob is rotated, the treatment region grows and shrinks and a gear train turns a lead screw which moves the stop. Thus, sensors coupled to the stops track the projected safety/treatment boundary.

Alternatively, in other embodiments, the position(s) and size(s) of the treatment and/or safety boundaries may be adjusted on the controller and/or display screen using an appropriate interface, such as a keyboard, joy stick, mouse, touch panel, touch screen, or the like. Once the treatment and/or safety boundaries are properly (virtually) positioned on the screen, the controller can control the deployment of the needle structure on the treatment probe. For example, the controller could position servo motors on the probe to position the needle/tine stops or could directly position the needles/tines without the use of stop structures.

In addition to the needle stop, the probe will usually also have a tine stop which determines the extent to which a plurality of tines may be advanced from the needle. While the present disclosure generally refers to a single tine stop, other embodiments may employ multiple tine stops, and the individual tines may be individually controlled or be controlled in groups of less than the whole. The tine stop will be configured to be monitored by the system controller so that the controller can calculate the size of the treatment or safety boundary as the tine stop is adjusted. Additionally, once the desired position and size of the treatment and/or safety boundaries are determined, the tine stop will act to limit the travel of the tines so that they are physically deployed in a pattern which provides treatment within the desired treatment/safety boundaries when energy is delivered through the needle structure.

Once the needle stop and tine stop have been set, and the needle structure has been advanced in tissue to the limits defined by the stops, energy may be delivered through the needle structure to treat the tissue. The energy, of course, will be delivered at a treatment power and/or treatment time which has been used to calculate the treatment region and/or safety region boundaries. In some embodiments, it will be possible for the controller to adjust the position or size of the treatment or safety boundaries based on the power, time and/or other treatment parameters (in addition to needle/tine position) which have been selected by the physician. In this way, both the needle/tine positions and the power and time of energy delivery are taken into account to calculate the position or size of the treatment or safety boundaries. Alternatively, drug delivery, tissue morcellation, and other therapies could be delivered through the deployed needle structure.

Optionally, virtual needle location information can be projected onto the real-time image while the position and/or size of the treatment and/or safety boundaries are being adjusted. For example, the needle location information could comprise a plurality of fiducials or markers which are projected onto the real-time image to indicate the projected positions of the needle tip(s), or other needle position information. In other cases, it would be possible to project complete images of the needle lengths as they would travel through the tissue (but prior to actual deployment). The needle location information would, of course, preferably be updated as the probe stops are being adjusted and would allow the physician to see where the needle will be after needle deployment.

In another aspect of the present invention, a system for treating an anatomical feature in tissue comprises a real-time image display, a treatment probe, and a positionable stop structure on the treatment probe. The treatment probe carries a deployable needle structure and an imaging transducer, wherein the transducer is connectable to the real-time image display. The position stop structure on the probe (1) controls at least one of a position or size of a treatment or safety region projected on the real-time image display and (2) physically limits deployment of the needle structure so that subsequent treatment of the tissue is within the treatment and/or safety region.

An exemplary needle structure comprises a needle and a plurality of tines which may be advanced from the needle. The tines assume a distally diverging pattern as they are advanced from the needle, and the stop structure typically comprises a needle stop element and a separate tine stop element. The needle stop element at least partially controls the position of the treatment or safety region projected on the real-time image display and the tine stop element at least partially controls the size of the treatment or safety region projected on the real-time image display.

The treatment systems may optionally further comprise a controller connectible to the probe for delivering energy to the needle structure, where the system is configured to control the projected treatment size or projected safety region size based upon both an energy level to be delivered by the controller and the position of the stop element(s) which may be tracked by sensors on the treatment probe

In a further aspect of the present invention, an imaging and therapeutic delivery system comprises an imaging component comprising an imaging shaft having a proximal end, a distal end, and an imaging transducer at the distal end. A needle component comprising a needle shaft having a distal end and a proximal end and a needle structure reciprocally disposed on or within the shaft is configured to removably attach to the imaging shaft with the shafts lying side-by-side with their respective axes in parallel.

In specific examples, the imaging transducer on the imaging shaft is pivotally attached at the distal end of the imaging shaft, and the distal end of the needle shaft is disposed proximally of the pivotally attached imaging transducer when the needle shaft is attached to the imaging shaft. The needle structure in the needle shaft typically reciprocates distally along the axis of the needle shaft, and the imaging transducer pivots away from the axis of the needle shaft when the needle shaft is attached to the imaging shaft. The imaging component may further comprise an imaging handle section attached to a proximal end of the imaging shaft, and the needle component may further comprise a needle handle section attached to a proximal end of the needle shaft. In such embodiments, the imaging handle section and needle handle section will typically form a complete handle when the needle shaft is attached to the imaging shaft. The imaging handle section usually has an interior which holds circuitry configured to connect the imaging transducer with an external imaging display and the needle handle section including mechanisms for advancing the tine needle structure, and the imaging handle section usually further comprises mechanisms for pivoting the imaging transducer relative to the imaging shaft.

In a still further aspect of the present invention, a method for deploying a plurality of tines from a needle in tissue comprises providing a real-time image of the tissue, including an anatomical feature to be treated, on a display. The needle is penetrated into tissue proximate the anatomical feature, typically in a distal direction, and tines are deployed from the needle further into the tissue. As with previous embodiments, the tines typically diverge radially as they are advanced distally from the needle to increase the volume of tissue to be treated. At least one of a treatment boundary and a safety boundary are projected onto the display in response to the tine deployment. An extent of the tine deployment can be adjusted to change the size and/or shape of the treatment and/or safety boundary which is projected on the display. In contrast to prior embodiments, the physician is able to position the needle and tines without having previously virtually projected the safety and/or treatment boundaries onto the image of the anatomy. Instead, the actual needle and tine deployment can be relied on to position and reposition the safety and/or treatment boundaries on the real time image until the physician is satisfied that a subsequent treatment will be both safe and effective using the actually deployed needle and tine configuration. In addition to the actual needle and tine deployment, of course, the projected treatment and/or safety boundaries will also depend on the intended power and time lengths of the treatment in a manner analogous to the projections of the virtual boundaries discussed previously. After an acceptable size and/or safety boundary has been achieved, the treatment may be delivered through the tines. In particular embodiments, deployment of the tines may be tracked via sensors in a needle/tine deployment mechanism on a probe used to deploy the needle and tines. In such cases, penetrating the needle will comprise advancing the needle from the probe which has been penetrated into the tissue. Usually, the extent of needle deployment from the probe will also be relied on in determining the projected safety and/or treatment boundaries on the display.

In still further aspects of the present invention, a system for treating an anatomical feature in tissue comprises a real-time display connected to a controller. The system projects and adjusts a size of at least one of a treatment boundary and a safety boundary onto the display. A treatment probe having a deployable needle structure and an imaging transducer is provided which is connectable to the controller and the display. The treatment probe carries at least one servo drive motor which is connected to and driven by the controller. The controller is configured to drive the servo motor to position the needle structure to provide a treatment which is effective over the region defined by the treatment boundary and which does not extend significantly beyond the safety boundary.

In specific embodiments of the system, the needle structure may comprise a needle and a plurality of tines advanceable from the needle in a distally diverging pattern. The at least one servo motor may comprise a first servo motor which drives the needle and a second servo motor which drives the plurality of tines. The system usually comprises a user interface configured to allow the user to virtually adjust the size and/or a position of the treatment and/or safety boundary on the display. In some instances, as described previously, an interface may be on the treatment probe itself. In other cases, the interface may comprise a more conventional keyboard, mouse, roller ball, touch screen, voice activation, or the like which is connected to the controller to allow the user to virtually position the needle structure prior to actually positioning the needle structure. In still other embodiments, the treatment probe may comprise servo motors for positioning the needle structure and/or sensors for detecting the extent to which the needle structure has been deployed. In such cases, the user may position the needle structure using the servos (without having generated a virtual projection of the safety and/or treatment boundaries), and observe the projected safety and/or treatment boundaries as they are calculated and projected by the system controller. In all cases, the system can be used to deliver energy or other treatments only after the deployment of the needle structure has been confirmed to meet the requirements of the safety and/or treatment boundaries.

All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG.1 is a schematic illustration of the system of the present invention comprising a system controller, an image display, and a treatment probe having a deployable needle structure and imaging transducer.

FIG.2 is a perspective view of the treatment probe of the present invention.

FIG.3 is a view of the treatment probe ofFIG.2 illustrating an imaging component of the probe separated from a needle component with portions broken away and portions enlarged.

FIG.3A illustrates a distal end of the needle component being connected to a distal end of the imaging component.

FIGS.4A through4F illustrate the internal mechanisms of the needle deployment component of the probe, including a needle stop housing and a needle carriage, showing how the mechanisms are manipulated in order to deploy the needle structure.

FIGS.5A and5B illustrate an interlock mechanism which prevents deployment of the needle structure prior to deflection of an imaging array on the imaging component of the probe.

FIGS.6A and6B illustrate a gear train mounted on the needle stop housing used to deploy a needle and a plurality of tines of the needle structure.

FIGS.6C and6D illustrate details of the needle carriage.

FIGS.7A through7C show relative movement of the needle carriage and needle stop housing.

FIG.8 is a bottom view of the needle carriage.

FIG.9 illustrates a distal portion of the treatment probe introduced into a uterine cavity to image a fibroid in the myometrium.

FIGS.10A-15A illustrate “screenshots” of the real-time image display as the treatment and safety boundaries are being adjusted using the treatment probe in accordance with the principles of the present invention.

FIGS.10B-15B illustrate manipulation of the handle which corresponds to the repositioning of the projected images of the treatment and safety boundaries on the real-time images ofFIGS.10A-15A.

FIGS.16A-16D illustrate the provision of fiducials or markers on the real-time image, where the fiducials or markers correspond to needle tip locations.

FIG.17A-17C illustrate an alternative construction of the needle housing of the present invention having sensors for detecting the positions of the needle carriage and the tine slide as they are positioned to deploy the needle and tines, respectively.

FIGS.18A and18B illustrate a further alternative embodiment of the needle housing of the present invention employing servo motors and drive screws for positioning both the needle carriage and the tine slide.

FIG.19 illustrates a system diagram where real-time ultrasound image data is relied on to determine the positions of the needle structures of the present invention.

FIG.20 illustrates a system diagram where external needle tracking data is used for tracking the needle position.

DETAILED DESCRIPTION OF THE INVENTION

As illustrated inFIG.1, asystem10 constructed in accordance with the principles of the present invention includes asystem controller12, animaging display14, and atreatment probe16. Thesystem controller12 will typically be a microprocessor-based controller which allows both treatment parameters and imaging parameters to be set in a conventional manner. Thedisplay14 will usually be included in acommon enclosure18 together with thecontroller12, but could be provided in a separate enclosure. Thetreatment probe16 includes animaging transducer20 which is connected to thecontroller12 by animaging cord24. Thecontroller12 supplies power to the treatment probe via atreatment cord22. Thecontroller12 will typically further include an interface for the treating physician to input information to the controller, such as a keyboard, touch screen, control panel or the like. Optionally, a touch panel may be part of theimaging display14. The energy delivered to the treatment probe by the controller may be radiofrequency (RF) energy, microwave energy, a treatment plasma, heat, cold (cryogenic therapy), or any other conventional energy-mediated treatment modality. Alternatively or additionally, the treatment probe could be adapted to deliver drugs or other therapeutic agents to the tissue anatomy to be treated. In some embodiments, probe16 plugs into an ultrasound system and into a separate radiofrequency (RF) generator. An interface line connects the ultrasound system and the RF generator.

Referring now toFIGS.2 and3, thetreatment probe16 comprises aneedle component26 and animaging component28. The needle component and imaging component are constructed as separate units or assemblies which may be removably attached to each other for use. After use, the needle component may be separated and will typically be discarded while the imaging component will be sterilized for reuse. Thetreatment probe16 is shown in its fully assembled configuration inFIG.2 and is shown in its disassembled configuration inFIG.3. In other embodiments of the present invention, the needle component and the imaging component could be combined in a single, integrated handle unit.

Theneedle component26 comprises ahandle portion27 having a slidably mounted targetingknob30 on its upper surface. The targetingknob30 controls the positioning of internal stops within the handle which are monitored by the controller12 (FIG.1) in order to calculate the size and position of the boundaries of the targeting region and/or the safety region which are shown on thedisplay14. The stops will also serve to physically limit deployment of theneedle56 and optionally tines57, as will be described in more detail below.

Theneedle56 is deployed from theneedle shaft34, and the needle and optional tines together form a needle structure which may be constructed, for example, as previously described in commonly owned U.S. Pat. Nos. 8,206,300 and 8,262,574, the full disclosures of which are incorporated herein by reference.

Thehandle portion27 of theneedle component26 further includes afluid injection port32 which allows saline or other fluids to be injected through theneedle shaft34 into a target region in the tissue being treated, such as the uterus. The needle handle27 also includes aneedle slide36, aneedle release38, and atine slide40 which are used to deploy theneedle56 andtines57, as will be described in more detail below. Theimaging cord24 is attachable at a proximal end of thehandle portion27 of theimaging component28 for connection to thecontroller12, as previously described.

Theimaging component28 comprises ahandle portion29 and animaging shaft44. Adeflection lever46 on thehandle portion29 can be retracted in order to downwardly deflect theimaging transducer20, as shown in broken line inFIG.3. A needlecomponent release lever48 is coupled to a pair oflatches50 which engage hooks52 on a bottom surface of thehandle portion27 of theneedle component26. Theneedle component26 may be releasably attached to theimaging component28 by first capturing a pair of wings58 (only one of which is shown inFIG.3) on theneedle shaft34 beneathhooks60 on theimaging shaft44, as shown inFIG.3A. A bottom surface of theneedle handle portion27 may then be brought down over an upper surface of theimaging handle portion29 so that thehooks52 engage thelatches50 to form a complete assembly of thetreatment probe16, where the handle portions together form a complete handle, for use in a procedure. After use, the needlecomponent release lever48 may be pulled in order to release thehooks52 from thelatches50, allowing thehandle portions27 and29 to be separated.

In use, as will be described in more detail below, the targetingknob30 is used to both position (translate) and adjust the size of a virtual treatment region which is projected onto thedisplay14 of thesystem10. Theknob30 may be moved distally and proximally in a slot on an upper surface of thehandle portion27 in order to translate the position of the treatment/safety region on the image, and the knob may also be rotated in order to adjust the size of the boundary of the treatment/safety region. Sliding and rotating theknob30 will also adjust the position of mechanical stops in thehandle portion27 which limit the deployment of theneedle56 andtines57 so that, once the virtual boundaries of the treatment/safety region have been selected on the real-time image, the needle and tines may be automatically advanced to the corresponding deployment positions by moving theneedle slide36 andtine slide40 until their movement is arrested by the stops. The position of the treatment/safety region is also dependent on the location at which the physician holds thetreatment probe16 within the target tissue. Thus, advancement of the needle and tines using theslides36 and40 will result in the proper placement of the needle and tines within the target tissue only if the treatment probe position is held steady from the time the stops are set until advancement of the needle/tines is completed. In preferred embodiments, rotating theknob30 will also determine the length of and/or power delivery during a treatment protocol. Thus, the knob may be used to virtually size the treatment/safety region based not only on the degree to which the tines have been advanced, but also the amount of energy which is being delivered to the target tissue.

Referring now toFIGS.4A through4F, construction of theneedle handle portion27 and internal components thereof will be described in greater detail. Note that the orientation of theneedle component26 is reversed relative to that shown inFIGS.2 and3 so that theneedle shaft34 is extending to the right inFIGS.4A-4F rather than to the left as shown inFIGS.2 and3. Thehandle portion27 of theneedle component26 is shown with its upper portion partially removed in each ofFIGS.4A through4F. Aneedle stop housing64 is slidably mounted in the housing with ashaft31 ofknob30 traveling in a slot33 (FIG.2) as thehousing64 is translated.

Aneedle carriage68 is also slidably mounted in thehousing portion27 and carries atine stop66 which is mounted on alead screw72. Theknob30 is coupled to thelead screw72 by agear train71 which turns adrive shaft70 which is slidably inserted into thelead screw72. Thedrive shaft70 will have an asymmetric cross-section which slides into and out of a mating passage axially aligned in thelead screw72. Thus, theknob30 can be used to rotate the lead screw independent of the relative axial positions of the needle stophousing64 and theneedle carriage68.

As will be explained in more detail below,treatment probe16 has a number of interlock features which prevent unintentional actuation of the stops, needle, and tines as well as requiring that the stop positions and needle/tine actuations be performed in a proper order. As part of this interlock system,pawls74 are provided on a side of the needle stophousing64 such that thepawls74 engage with a rack of teeth132 (FIG.8) on the inside of thehandle portion27 housing to prevent motion of the needle stophousing64 unless the pawls are disengaged. The pawls are disengaged by depressing theknob30 which allows the knob to be moved distally and proximally on thehandle portion27 in order to reposition the needle stophousing64 in thehousing portion27. When the knob is released, thepawls74 re-engage, locking the needle stophousing64 in place relative to thehandle portion27.

Similarly, pawls76 (FIGS.4A and4B) are provided on theneedle carriage68. These pawls also engage a rack of teeth134 (FIG.8) on the inside of the housing ofhandle portion27. Thepawls76 are normally engaged, locking thecarriage68 in place, but may be disengaged by pressing on the T-shapedrelease38, allowing the carriage to be pushed forward in order to distally advance theneedle56 which has a proximal end (not shown) carried by the carriage. Thetines57 are advanced from theneedle56 by thetine slide40, as will be described below.

As shown inFIG.4B, the positions of the needle stophousing64 and thetine stop66 are sensed by theneedle position sensor78 and thetine position sensor80, respectively. These sensors are typically rheostats with a change of position resulting in a change of resistance which is sensed by thecontroller12, but other absolute position feedback devices, such as. LVDT, quadrature encoders or the like could also be used. Thus, prior to deployment of the needle or tines, the positions of the needle stophousing64 and tine stop66 may be tracked in real time by thecontroller12 and the calculated treatment and/or safety boundaries displayed on thedisplay unit14 as the position of the needle stop housing is adjusted and theknob30 rotated to adjust the position of the tine stop. Of course, the actual positions of the stops could also be visually or numerically shown on thedisplay14. Prior to any actual deployment of the needle and tines, the physician will have visual information confirming the treatment/safety region boundaries which will result from the needle/tine deployment which has been set into the treatment probe by adjusting the needle and tine stops.

A particular advantage of this method and system is that the physician can manipulate the treatment/safety boundaries over the target anatomy by either moving the boundaries relative to (or within) the real-time image by manipulating (sliding and turning)knob30 or moving the entire real-time image with respect to the target anatomy by manipulating theentire treatment probe16 in order to get the treatment boundary over the tumor and keeping the safety boundary away from sensitive anatomy. So, before the physician advances any needles into the patient tissue, they can confirm in advance using the virtual targeting interface that the ablation will be effective and safe.

Referring toFIG.4A, to virtually position the boundaries of the treatment/safety regions, the targetingknob30 may be depressed and the knob moved distally in the direction ofarrow84, reaching the position shown inFIG.4C. The physician will, of course, be able to move the needle stop housing both distally and proximally so long as theknob30 is depressed, until the boundary of the treatment/safety region is properly located as shown on thevisual display14. Once properly positioned, theknob30 is partially depressed to disengage rotation lock110 (FIG.6B), and the knob may be rotated as shown byarrow86 to position thetine stop66. More specifically, rotation ofknob30 rotates driveshaft70 via thegear train71. The drive shaft, in turn, rotateslead screw72 which moves thetine stop66 distally as shown byarrow88 inFIG.4D.Knob30 can, of course, be rotated in either direction in order to reposition thetine stop66 distally or proximally, which repositioning causes the “virtual” boundary projected ondisplay14 to expand or contract, respectively (FIG.4D). Once the needle stophousing64 and thetine stop66 are in their desired positions (based on the virtual or projected images of the treatment/safety boundary on display14), the treating physician can then physically advance the needle and the tines to the positions preset by the needle stop housing and tine stop. Referring toFIG.4D, theneedle release38 is pushed in to disengage thepawls76 and allow theneedle carriage68 to be moved in the direction ofarrow88. Theneedle carriage68 is advanced until hitting the needle stophousing64 as shown inFIG.4E. Such motion of the needle carriage, in turn, distally advances theneedle56 as shown in broken line inFIG.3.

After theneedle56 has been advanced, thetines57 may be advanced by manually pushing thetine slide40 distally until thetine slide40 hits thetine stop66 as shown by arrow90 inFIG.4E. Once theslide40 is positioned distally, as shown inFIG.4F, theneedle56 andtines57 will be deployed, as shown inFIG.3. At this point thecontroller12 detects that theneedle56 andtines57 have been fully extended and the physician confirms that the ablation will be of the correct size and at a safe and effective location. The tineslide locking arm120 releases thetine slide40 when theneedle carriage68 engages thestop housing64. Thus, the switch on thetine stop66 can be active only if thetine slide40 was first released when theneedle carriage68 engaged thestop housing64, with thesingle microswitch112 indicating that theneedle56 and thetines57 are in their proper positions.

Referring now toFIGS.5A and5B, an interlock assembly for preventing motion of theneedle carriage68 prior to deflection of the image transducer20 (FIGS.2 and3) will be explained. Thetransducer deflection lever46 is initially pushed forwardly as shown inFIG.5A, where thetransducer20 is in its axially aligned configuration, as shown inFIGS.2 and3. It will be appreciated that needle advancement while thetransducer20 is aligned axially would likely damage the transducer. To avoid such damage, as it is retracted, thelever46 engages a fourbar linkage92 which is coupled to anangle lock94 which prevents movement of theneedle carriage68. When thelever46 is pulled proximally, however, to deflect the transducer20 (as shown in broken line inFIG.3), the four bar linkage is allowed to collapse and disengage theangle lock94, as shown inFIG.5B. In this configuration, theneedle carriage68 is free to be advanced and retracted. In other embodiments, a leveraged or pivoting beam could replace the four bar linkage.

Details of the gear train which allows theknob30 to rotate to thedrive shaft70 are shown inFIG.6A and6B. The knob is attached tobevel gear100 which rotates a bevel/spur combination gear102 which in turn drives thespur gear104 attached to thedrive shaft70. Depressing theknob30 retracts thepawls74 through interaction withdowel pin108 which is moved up and down by theknob30 and rides in slots or channels in the pawl surfaces. Arotation lock110 is provided and engages the bevel gear to prevent rotation of the knob. Amicroswitch112 is provided which signals to the controller when therotation lock110 andpawls74 are engaged.

Referring now toFIGS.6C and6D, more details of theneedle carriage68 will be described.FIG.6C is a top view of theneedle carriage68, generally as shown in previous figures.FIG.6D is a bottom view of the needle carriage showing details not previously visible. Theangle lock94 translates anarm96 which allows or prevents theneedle release38 from being actuated. As shown inFIG.6D, theangle lock94 is engaged (as shown inFIG.5A). By retracting lever46 (FIG.5B), theangle lock94 would disengage to withdraw thearm96 to allow theneedle release38 to be depressed. Theneedle release38, in turn, retractspawls76 which disengage with lockingteeth134 onhandle portion27.

Abracket114 on thetine slide40 engages with a shaft (not shown) which advances the tines within the needle, as will be described below. Similarly, abracket116 fixed to theneedle carriage68 engages a proximal end of the needle (not shown inFIG.6D) which will advance the needle as the carriage is advanced.

One additional lock out is shown inFIG.6D. A spring loadedplunger140 projects out a back oftine slide40. When thetine slide40 is pushed up against theneedle slide36, (i.e., when the tines are not deployed), the spring loadedplunger140 actuates theangle lock94 and engages thearm96 to lock out theneedle release38. When thetine slide40 is moved away from theneedle slide36, theplunger140 disengages theangle lock94 and thearm96 unlocks theneedle release38. Of course, other lock out mechanisms could be employed. For example, thetine slide40 could engage a simple lever that directly interfaces with theneedle release68 without using a spring loadedplunger140.

Referring now toFIGS.7A through7C, a mechanism for selectably locking thetine slide40 prior to advancing theneedle carriage68 will be described. Atine locking arm120 is attached via apivot122 on a side of theneedle carriage68, as shown inFIG.7A. Aside arm124 of thelocking arm120 is disposed to engage abar126 fixed to the end of the needle stophousing64 which engages the needle carriage when the needle carriage is fully advanced. As theneedle carriage68 is advanced distally (to the left inFIGS.7A and7B) to deploy the needle, thebar126 onneedle stop housing64 will engage theside arm124 on thetine locking arm120. Such engagement will cause the locking arm to rotate in a counter-clockwise direction, thus raising a lockingend128 of the bar from an engagement configuration (FIG.7A) to a non-engagement configuration (FIG.7B) such that thetine slide40 may be advanced distally only after the needle carriage has been fully advanced. In this way, accidental, premature deployment of the tines may be prevented.

One skilled in the art will appreciate that there are many ways to design the lock outs that control the order of deployment of the components of the treatment probe. For example, thebar126 could be integrated intoside124 rather than64. Thelockout120 could be designed as a leaf spring so that it does not rely on gravity to engage lockingend128 withtine slide40.

FIGS.7B and7C illustrate how thearm96 of theangle lock94 is raised in order to lock theneedle release38 to prevent accidental needle deployment.

Referring now toFIG.8,inner teeth132 and134 are formed on an interior surface of thehousing portion27 of theneedle component26 of thetreatment probe16. Theteeth132 selectively engagepawls74 disposed on the needle stophousing64, as previously described. Theteeth134 selectively engage pawls76 (not shown inFIG.8) which are on theneedle carriage68.

Referring now toFIG.9, thesystem10 of the present invention can be used to treat a fibroid F located in the myometrium M in a uterus U beneath a uterine wall UW (the endometrium) and surrounded by the serosal wall SW. Thetreatment probe16 can be introduced transvaginally and transcervically (or alternately laparoscopically) to the uterus, and theimaging transducer20 deployed to image the fibroid within a field of view indicated by the broken lines.

Once the fibroid is located on thedisplay14, as shown inFIG.10A, the controls on the handle will be used to locate and size both a treatment boundary TB and a safety boundary SB. Initially, as shown inFIG.10A, the virtual boundary lines TB and SB are neither positioned over the fibroid nor properly sized to treat the fibroid. Prior to actual needle and tine deployment, the physician will want to both position and size the boundaries TB and SB for proper treatment. As theimaging transducer20 is already positioned against the uterine wall UW the only way to advance the treatment and safety boundaries is to move the boundaries forward by depressing the targetingknob30, as shown inFIG.10B, and then distally advancing the knob as shown inFIG.11B. This will cause the treatment and safety boundaries TB and SB to move forwardly along the axis line AL. This causes the virtual boundaries on the real-time image display14 to move over the image of the fibroid, as shown inFIG.11A.

As shown inFIG.11A, however, the size of the treatment boundary TB is insufficient to treat the fibroid since the boundary does not extend over the image of the fibroid. Thus, it will be necessary to enlarge the treatment boundary TB by rotating the targetingknob30, as shown inFIG.12B. This enlarges both the treatment boundary TB and the safety boundary SB, as shown inFIG.12A. While the enlarged virtual treatment boundary TB is now sufficient to treat the fibroid, the safety boundary SB has extended over the serosal wall SW, as also shown inFIG.12A. Thus, there is risk that the treatment would affect more sensitive tissue surrounding the uterus, and it is necessary that the virtual safety boundary SB be retracted by turning the targetingknob30 in an opposite direction, as shown inFIG.13B. This reduces the size of both the safety and treatment boundaries SB and TB, as shown inFIG.13A, and the physician has confirmation that the treatment will be effective because the treatment boundary TB completely surrounds the fibroid on the real-time image display, and that the treatment will be safe because the safety boundary SB is located within the myometrium M and does not cross the serosal wall SW on the real-time image display. In addition, the surgeon knows that the stops in the treatment probe are now appropriately set to deploy the needle and tines to achieve the treatment result shown by the virtual boundaries inFIG.13A.

While holding thetreatment probe16 steady, the physician then advances the needle slide36 (after depressing the release), as shown inFIG.14B, causing theneedle56 to extend into the fibroid F, as shown inFIG.14A. The illustration in14A includes a representation of thetreatment probe16 which corresponds to the physical probe which is present in the patient. The remainder ofFIG.14A corresponds to the image present on thetarget display14.

Afterneedle56 has been fully deployed as limited by the needle stophousing64 in thetreatment probe16, thetines57 may be deployed by advancing thetine slide40 until it engages thetine stop66, as shown inFIG.15B. Optionaly, thetreatment probe16 may be rotated about a central axis (typically aligned with the axis of the needle56) to confirm the treatment and safety boundaries in all planes of view about the fibroid.Display14 will show the position of the treatment and safety boundaries in real time relative to the target fibroid and serosa. The tines are then configured as shown inFIG.15A, and power can be supplied to the tines (and optionally the needle) in order to achieve treatment within the boundary depicted by the virtual treatment boundary TB. Again,FIG.15A mixes both the virtual image which would be present on thedisplay14 as well as the physical presence of thetreatment probe16.

Referring now toFIG.16A through16D, thecontroller12 can be programmed to display fiducials or markers on theimage display14, where the fiducials or markers represent particular locations on the “virtual” needle and/or tines. For example, as shown inFIG.16A,marker140 may represent a position on theneedle56, for example, the location from which the tines will diverge. Anadditional marker142 may be provided which represents the tip of the needle. A plurality ofadditional markers144 may represent the tips of the tines. The use of fiducials ormarkers142 and144 help the physician confirm that the actual needle and tines are deployed correctly. The physician should be able to observe the real-time images of the actual needle and tines during deployment, and the associated tips should move until the needle tip reachesmarker142 and the tine tips hitmarkers144. (or alternatively the alternative targets inFIGS.16B-16D as described below).

FIG.16B is similar toFIG.16A, except that the fiducials representing the tips of the tines are depicted asarcs146 which represent a range of possible positions for the distal tips of each tine. Such additional information may be useful for the physician when determining both adequacy of treatment and safety risks. As shown inFIG.16B, each arc has a radius equal to the theoretical electrode deployment length. As shown inFIG.16C, arcs148 all have the same radius measured from the origin located at thetip142. Finally, inFIG.16D, the arcs ofFIG.16C are joined into a continuous arc which is intended to present a more clear visual presentation for use by the physician.

As described thus far, the illustrated embodiments of the needle housing have all included mechanisms for placing a needle stop and a tine stop for both adjusting the virtual images of the treatment and safety boundaries on the display screen and for subsequently positioning the actual needles and tines in the patient tissue for treatment. Analternative needle housing202 which dispenses with the needle and tine stops is illustrated inFIGS.17A-17C. Theneedle housing202 includes both atreatment cord204 and aneedle shaft206, both of which are generally the same in structure and purpose as described for previous embodiments, and the needle housing can be secured to and removed from animaging housing28 as described in the previous embodiments. Aneedle carriage208 within theneedle housing202 and atine slide214 within the needle carriage208 (FIG.17C), in contrast, are freely positionable by the user and are not limited by stops or any other motion limiting mechanisms. Instead, the position of theneedle carriage208 is tracked by a needlecarriage position sensor210 on the bottom of theneedle housing202, as best seen inFIG.17A. Similarly, thetine slide214 is tracked through aposition sensor216 which is on an upper portion of theneedle carriage208, as best seen inFIG.17C.

The physician or other user may virtually position the treatment boundary and/or the safety boundary on a display screen using an interface other than thecontrol knob30 as described for previous embodiments. For example, the treatment and/or safety boundaries may be positioned on a display screen having a real time image of the uterine anatomy using a keyboard, a mouse, a roller ball, a touch screen, voice activation, or any other conventional interface used with computer and other displays. The virtual treatment and/or safety boundaries will be set relative to the actual position of theneedle shaft206 which can be tracked by the system using the image of the shaft in tissue. After the physician is satisfied with the placement of the virtual treatment and/or safety boundaries, the physician can then manually advance the needle while the system controller monitors the advancement through thesensor210 in theneedle housing202. Through visual, audible, or other means, the system can alert the physician when the needle has been advanced by the appropriate distance. After locking the needle, the user can then advance the tines manually while the controller monitors their position via thesensor216. The system will again alert the physician when the tines have been deployed by the appropriate amount within the limits of the virtual treatment and/or safety boundaries. The system can then alert the physician that treatment may commence.

A still further alternative embodiment of aneedle housing230 is illustrated inFIGS.18A and18B. Theneedle housing230 again includes atreatment cord232 and aneedle shaft234 which are generally the same as those described for all previous embodiments. Aneedle carrier236, however, differs from previous embodiments in that it is driven by adrive screw240 which in turn is driven by aservo motor242. The servo motor will be controlled by thesystem controller12 based on information relating to the boundaries of the treatment region and/or safety region, which can be produced by any of the methods discussed previously.

Similarly, a tine slide244 is driven by a tineslide drive screw246, as best seen inFIG.18B. The tine slide drive screw, in turn, is driven by atine servo motor248 which is also driven and controlled by the system controller. Theneedle carrier236 may further comprise a needlecarrier position sensor250 and a tineslide position sensor252, although such position sensors are not essential since the servo motors should provide accurate position data regarding theneedle carrier236 and the tine slide244. The position sensors, however, are useful since they allow for initializing the positions and for confirming the positions during the needle and tine deployment operations. The tineslide position sensor252 can be connected through aflexible connector strip254.

Embodiments employing servo-driven needles and tines may be combined with most of the previously described embodiments, including both embodiments where the treatment and/or safety boundaries are determined virtually prior to needle deployment in those embodiments where the treatment and/or safety boundaries are determined while the needle structures are being deployed.

Referring now toFIG.19, in certain embodiments of the present invention, the needle and/or tine positions may be determined based on the ultrasound image information rather than on information from the treatment probe configuration. As shown, an ultrasound data stream from the on-board imaging transducer provides both the normal image which is presented on the display and provides the needle image and location information to the system controller. The user inputs the boundary locations to the system controller by any of the ways described previously. The system controller can then calculate the treatment and/or boundary regions and compare those to the actual boundaries which would be obtained based on the monitored needle/tine positions.

Referring now toFIG.20, the systems and methods of the present invention can also rely on external needle tracking, such as the use of radio frequency tags, for tracking real-time needle position in tissue. The real-time data can then be relied on by the system controller to determine whether the needles remain within the boundaries so that both safe and effective treatment can be effected.

While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby.

Claims (21)

What is claimed is:

1. A method for deploying a plurality of tines from a needle in tissue, said method comprising:

providing a real-time image of the tissue including an anatomical feature to be treated on a display;

penetrating the needle into the tissue proximate the anatomical feature;

deploying the plurality of tines from the needle, wherein at least one of a treatment boundary or a safety boundary is projected onto the display, wherein the safety boundary comprises a minimum threshold distance beyond the treatment boundary where a risk of damaging tissue during the treatment is reduced; and

adjusting an extent of tine deployment to change a size and/or shape of the treatment and/or safety boundary projected onto the display;

wherein the treatment is delivered through the plurality of tines after adjusting the extent of tine deployment.

2. A method as inclaim 1, comprising tracking deployment of the plurality of tines via sensors in a deployment mechanism for deploying the plurality of tines.

3. A method as inclaim 1, wherein penetrating the needle comprises advancing the needle from a probe.

4. A method as inclaim 1, further comprising adjusting an extent of the needle deployment to a location of the treatment and/or safety boundary projected on the display.

5. A method as inclaim 1, wherein adjusting the size and/or position of the projected boundary comprises adjusting a user interface connected to the controller.

6. A method as inclaim 5, wherein the interface is on the probe.

7. A method as inclaim 1, wherein the plurality of tines are advanceable from the needle in a distally diverging pattern, and wherein an extent of advancement of the plurality of tines at least partly determines the size of the treatment region and/or the safety region.

8. A method as inclaim 1, further comprising deploying the needle from a probe.

9. A method as inclaim 8, wherein the needle is deployed from the probe prior to deploying the plurality of tines from the needle.

10. A method as inclaim 8, wherein deploying the needle comprises distally advancing a slider of a handle coupled to the probe.

11. A method as inclaim 1, wherein deploying the plurality of tines comprises distally advancing a slider of a handle coupled to the probe.

12. A method as inclaim 1, further comprising delivering energy through the needle and one or more tines of the plurality of tines to the tissue.

13. A method as inclaim 1, further comprising controlling at least one of treatment power or treatment time to limit an extent of tissue treatment to be within the treatment region and/or safety region.

14. A method as inclaim 1, further comprising projecting virtual needle structure stop location information onto the display.

15. A method as inclaim 14, wherein the virtual needle structure stop location information comprises markers representing locations on the needle and the plurality of tines after deployment.

16. A method as inclaim 1, further comprising projecting actual needle structure location information onto the display.

17. A method as inclaim 16, wherein the actual needle structure location information is derived from sensors on the probe which track needle deployment.

18. A method as inclaim 16, further comprising deploying the needle from a probe, wherein the actual needle location information is updated on the display as the needle is deployed.

19. A method for deploying a plurality of tines from a needle in tissue, said method comprising:

providing a real time ultrasound image of the tissue including an anatomical feature to be treated on a display;

displaying a probe as the probe is positioned near the anatomical feature, the probe including the plurality of tines;

projecting an image of at least one of a treatment region for a treatment or a safety region on the real time image, wherein the safety boundary comprises a minimum threshold distance beyond a boundary of the treatment region where a risk of damaging tissue during the treatment is reduced;

adjusting a size and a position of a projected boundary of the projected image of the at least one of the treatment region or the safety region on the real time ultrasound image, wherein adjusting the size and the position of the projected boundary comprises user adjustment of a user interface; and

displaying the plurality of tines on the real time ultrasound image as the plurality of tines is deployed from the probe, wherein the plurality of tines is positioned to provide the treatment within the projected boundary after the projected boundary has been adjusted,

wherein the plurality of tines is deployed from the probe by distal advancement of a slider on the handle of the probe.

20. A method for deploying a plurality of tines from a needle in tissue, said method comprising:

providing a real time image of the tissue including an anatomical feature to be treated on a display;

displaying a probe as the probe is positioned near the anatomical feature, the probe including the plurality of tines;

projecting an image of at least one of a treatment region for a treatment or a safety region on the real time image, wherein the safety boundary comprises a minimum threshold distance beyond a boundary of the treatment region where a risk of damaging tissue during the treatment is reduced;

adjusting at least one of a size or a position of a projected boundary of the projected image of the at least one of the treatment region or the safety region on the real time image, wherein adjusting the at least one of the size or the position of the projected boundary comprises user adjustment of a first interface; and

displaying the plurality of tines on the real time image as the plurality of tines is deployed from the probe, wherein the plurality of tines is positioned relative to the probe and the tissue to provide the treatment within the projected boundary after the projected boundary has been adjusted,

wherein the plurality of tines is deployed from the probe by operation of a second interface on the handle of the probe.

21. A method as inclaim 1, wherein adjusting the extent of tine deployment to change the size and/or shape of the treatment and/or safety boundary projected onto the display comprises confirming with a user whether the size and/or shape of the treatment and/or safety boundary is acceptable.

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